insured information project information - …€¦ · · 2017-06-07name of substation: ... put...

23 Corporate Plaza, Suite 248 • Newport Beach, CA 92660 • p 949.873.0320

Power Energy Risk (PERse), is a subsidiary of RSG Underwriting Managers, LLC and Ryan Specialty Group, LLC, specializing in underwriting management and other services for insurance products distributed through agents and brokers. In California: RSG Insurance Services, LLC License # 0E50879 ©2017 Ryan Specialty Group, LLC

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Named Insured:

Named Insured Address:

Contact Person: Phone:

Additional Insureds:

Loss Payee:

Existing/Previous Insurance Carrier (if applicable):

Existing Policy Expiration Date:

PROJECT INFORMATIONProject Name(s):

Exact Site Address (orLongitude/Latitude[s]):*PLEASE ATTACH COPY OF SITE LAYOUT

Is land Leased or Owned: Number of Acres:

Year Commissioned: Installed MW Capacity:

Power Sold to:

Name of Substation:

Is Substation Owned and Insured by Project:

Does Substation serve other Wind Projects:

Name & MW Capacity of other Wind Projects:Number of Substation Transformers (if applicable):

1) If more than one, is the Substation configured to reroute all powerthrough one transformer:

2) If YES, what is the Redundancy Available Output (e.g., 30%, etc.):3) If YES, confirm a blast wall/fire separation between the two:

4) Substation Transformer Warranty Expiration Date:

Length of Transmission Lines within Project:

Length of Transmission Lines outside Project:Number of Solar Met Towers(if applicable):

Complete List of Spares onSite:

Security Details Onsite (e.g., fenced, 24/7 security, CCTV, controlled access, etc.):Details of Contingency Plans

Please provide any additionalinformation that will assist inevaluating the risk:

Manufacturer:

for Critical Equipment Failure:

INSURED INFORMATION

Type of Technology:

Mounting Type: (Roof / Ground / Carport)

If Rooftop, confirm all host buildingscomply with latest UBC or equivalentbuilding codes with respect to fireprotection and structural stability:

If Rooftop, confirm Mounting Systems to

comply with ASCE Standard 7-05 or equivalent recommendations for structural design:

Solar Module Manufacturer:

Certified By:

Production Type Certificate:

Are Solar Modules certified according toIEC 61215 or equivalent standards fordesign qualification and type approval:

Confirm Solar Modules, control rooms and O&M buildings to comply with NFPA standards or equivalent:Model Numbers: Number of Modules:

Warranty Expiration Date:

Warranty Details:(Solar Modules, inverters and substationto contain full parts and labor warranty

and power output guarantee)*PLEASE ATTACH COPY OF WARRANTY

Inverter Manufacturer:

Number of Transformers: Manufacturer:

Battery Energy Storage System (BESS):

1) Manufacturer:

2) Has their process been certified by GL orany other design certificate:

If NO, will they or are they in the process:

3) Warranty Information:

4) Is Energy Storage Container isolated fromSubstation:

If YES, approximate distance:

If NO, please advise configuration:

5) Fire suppression system within EnergyStorage Container:

6) Are there PPA requirements for EnergyStorage:



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7) How is Revenue Production calculated:

8) Is system designed to isolate itselfelectrically if it senses any systemirregularities:

9) Can Project(s) put full energy to gridindependent of the Energy StorageSystem:

Lead Time for Key Components:

Modules:

Inverters:

Transformer(s) / Other:

COVERAGES

OCEAN MARINE (OM – SECTION 1A) AND DELAY IN START-UP (DSU – SECTION 2A)OM Required: DSU Required:

Details of Equipment (e.g., Modules, Inverters, etc.):

Values of Equipment coming overseas:

Maximum Value any one conveyance:

Port of Origin(s):

Will there be any temporary storage at Portor Other Location:

Transportation Period: Start: End:

Where does the OEM’s Transit Insurance end:

Property Damage Deductible requested:

DSU Deductible requested:

Indemnity Period:*PLEASE ATTACH PANEL SUPPLY AGREEMENT

CONSTRUCTION ALL RISK (CAR – SECTION 1B) AND DELAY IN START-UP (DSU – SECTION 2A)CAR Required: DSU Required:

Construction Start Date: Est Completion Date*PLEASE ATTACH CONSTRUCTION SCHEDULE AND PANEL SUPPLY AGREEMENT

EPC/BOP Contractor:

Is any work subcontracted (if YES, pleaseanswer the following):

Are you named as an Additional Insured:

Do you waive your Rights for Subrogation:

Is Contractual Indemnification Mutual to youor to subcontractors:

Are Certificates of Insurance required for allsubcontractors:

*PLEASE ATTACH EPC/BOP CONTRACT



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Will this insurance cover be Primary orSecondary to any other insurance cover:

*IF SECONDARY, PLEASE PROVIDE EVIDENCE OF PRIMARY COVER


DSU Deductible requested:

Indemnity Period:

OPERATING ALL RISK (OAR – SECTION 1C), BUSINESS INTERRUPTION (BI – SECTION 2B), AND CONTINGENT BUSINESS INTERRUPTION (CBI – SECTION 2B)OAR Required: BI Required: CBI Required:

Inception Date of Operational Cover:

Project Operations and MaintenanceProvider:

Distance to nearest O&M Facility:

Warranty Service Provider(if other than O&M):

*PLEASE ATTACH O&M CONTRACT


BI Deductible requested:

CBI Deductible requested:

Indemnity Period:

Loss History (Last 5 Years):

Description:

Date of Loss:

Loss Amount (Paid and/or Reserved):

*PLEASE ATTACH LOSS RUNS (IF APPLICABLE)



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STATEMENT OF VALUES (Completed in detail)

SOLAR MODULE MANUFACTURERModule Value per Unit:

Module Total:

BALANCE OF PLANT (BOP)Inverters:

Mounting Structure:

Power Tower:

Transformers:

Substations:

Operating Building:

Transmission and Distribution Lines:

Computer Hardware (SCADA) and Software:

Spares:

Miscellaneous Other BOP:

BOP Total Values:

TOTAL PHYSICAL DAMAGE VALUE (WTG + BOP):

BUSINESS INTERRUPTIONProduction Tax Credits/ Incentives:

Annual Income for Power Production:

TOTAL BUSINESS INTERRUPTION



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TOTAL PHYSICAL DAMAGE VALUES + TOTAL BUSINESS INTERRUPTION= TOTAL INSURED VALUES (TIV):

GENERAL LIABILITYLimits Requested ($) - ACCORD APPLICATIONS OR EQUIVALENT REQUIRED FOR AUTO AND WC

General Liability:

Auto:

Workers Compensation:

Umbrella:

Other:

UMBRELLA - Additional Underlying Policy Terms:Auto: Limits:

Carrier:

Premium:

Workers Compensation: Limits:

Carrier:

Premium:

Other: Limits:

Carrier:

Premium:

AUTOLight (Less than 50 Miles): Number of Vehicles:

Radium of Operations:

Medium (51-150 Miles): Number of Vehicles:


Heavy (Greater than 150 Miles): Number of Vehicles:


A formal Driver Safety training program used forall Drivers:

All Drivers maintain a valid DL for class of vehicleoperated:

Are motor vehicles operating records reviewedfor all Drivers:

Describe International exposure (if any):

Describe watercraft or aircraft exposure (if any):

DECLARATION AND SIGNATUREI have read the above Application. I declare that to the best of my knowledge the statement and information on this Applicationand any attachments thereto are true, accurate, and complete. This information is given to the insurer for the specific purposeof obtaining insurance coverage. It is agreed that if any information given in the Application or in any attachments thereto ismaterially false, inaccurate or incomplete, the Insurer may deny coverage or cancel the policy.

Signature for Named Insured:

Title:

Submitted By (Producer):



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*IF NO, PLEASE PROVIDE LIST OF ALL DRIVERS INCLUDING DOB, DL, AND STATE

insured information project information - …€¦ · · 2017-06-07name of substation: ... put...

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